No one is ever trapped, truly, in any of the settings phobics dread, obviously not in restaurants or on a line at a bank, or standing about at a party or at a shopping center, but also not in elevators or airplanes. There are always ways of escaping. There is a keyhole on the outside of elevators; and a stuck elevator can be opened from the outside. Even airplanes can be induced to land. In this connection I report a singularly determined airline passenger who wanted to travel as quickly as possible to his home in Utah. There was no direct flight, so he booked a flight to Los Angeles; and when he was flying close to the airport near his hometown, he pretended to suffer a heart attack so the airplane would be forced into an emergency landing at that airport. He actually committed this antisocial act.

But in a more fundamental way, no one is trapped in an airplane any more than he would be in a movie theater. He can move up and down the aisles. He can go talk to someone else, or go to the bathroom. Indeed, modern air travel is like sitting in a movable movie theater.

More important, the phobic person must learn that he/she will not lose control during a panic attack, no matter how bad it gets and no matter what the circumstances. It is that thought that terrifies the phobic person. Loss of control means, in this context, a worsening of the panicky feelings until the phobic person does some awful thing: something embarrassing—such as fainting, falling to the ground, screaming, or vomiting—or dangerous—such as driving into a crowd or off a bridge. None of these things happen, but the phobic person can only be persuaded once and for all that that is true by having repeated panic attacks without leaving the phobic situation.

Still, there usually comes a time, after repeated panic attacks in different settings, that the fear of such attacks fade away; and the phobic person is cured. And yet after helping such patients to recover, it became clear to workers in our clinic that some patients continued to have other irrational fears. They were afraid of physical illness, usually a fatal illness, afraid of drugs and, sometimes, afraid of doctors. A few said they were afraid of dying, others said they were afraid of being dead. We called them “health worriers” and their condition, “health anxiety.”

It turns out they did not fit comfortably into conventional diagnostic categories. Some were especially afraid of germs; and they had symptoms of obsessive-compulsive disorder. Others had physical symptoms whenever they were anxious. They developed headaches or stomach aches, or any sort of pain—or a fast heart beat or a wobbly feeling. They fulfilled the criteria of “somatization disorder.” More typically, some of these patients, in the face of relatively ordinary physical symptoms, jumped to the conclusion that they had a very serious illness. The most common conditions were those that were insidious, without much in the way of symptoms, but which could kill nevertheless. Examples include brain or pancreatic cancer, H.I.V. , heart attacks, or multiple sclerosis. These patients could be diagnosed as hypochondriacs. But most of our patients overlapped these categories. The one common denominator they shared was their recognition that they worried too much about their health, and sometimes about the health of others in their families. It turned out that many of them shared certain ideas:

About physical illness. That any illness, perhaps most of them, is potentially serious. That such an illness must be treated urgently to avoid dire consequences. That most illnesses do not go away untreated. That the ordinary physical symptoms of anxiety, including stomach distress, light-headedness and vague physical pains are more likely in their case to be caused by a serious illness. They feel that they are likely to get sicker than other people, and sicker more often. No matter how rare the disease might be, they figured “with their luck,” they would get it.

About the importance of sleep and diet and the regularity of other bodily functions, such as daily bowel movements.

About doctors. They were inclined to think that doctors were not reliable. If they were to get sick, they thought doctors would not take their complaints seriously and would be inclined to dismiss them as “emotional” or even imaginary.

About drugs. In their opinion drugs were always potent and dangerous. All things considered, it would be better not to be on drugs, and certainly not more than one at a time. They felt they were more likely to have drug side-effects than other people.

About physical examination and laboratory tests. They tended to think a good physical examination looked at “everything;” and would pick up any disease if it were present. Laboratory tests that fell out of the normal range, had to mean something, usually something bad.

About death and dying. They imagined the process of dying to be marked by awful pain. Underneath the fear of death were two other fears: of being alone and being helpless; and they imagined death in a hospital to epitomize those experiences. They imagined what the experience of their death would be on their children and on others who would survive them.

Finally, they imagined their health as precarious.

These ideas and others had to be attacked for such patients to feel less afraid once and for all. Just as the panicky patient has to learn not to fear the panic attacks, the health worrier has to learn how to approach illness realistically. As it often does in other emotional disorders, treatment comes down to testing out the world in certain ways—by confronting one’s fears. There are a number of things to do, and other things to avoid doing. For example, the patient cannot search out endlessly for reassurance. One more test will not comfort, any more than washing one’s hands compulsively and endlessly makes the obsessional person feel clean at last. Treatment summarizes to a kind of exposure therapy. It is the treatment of certain bad ideas. (These matters are discussed more fully in “Worried Sick?”) (c) Fredric Neuman Follow Dr. Neuman's blog at fredricneumanmd.com/blog

It would really be interesting if it turns out that the gene(s) related to ADHD can sometimes mutate on the Bipolar spectrum to create OCD. Maybe, hypo Mania is also a necessary ingredient to entrap consciousness.

That would really be a surprise.

I suspect that ''stuttering'' or having a ''lisp'' will be seen as a sign of ADHD combined with Bipolarity.

THANK YOU for this insightful article. A few life experiences have caused me to be constantly worried about my health, and I am acutely aware that I worry too much about it. This article organized perfectly all the thoughts and feelings I have been having for the past 2 years. Seeing these symptoms laid out makes me feel like I am not alone. Thank you!

I'm not surprised to be honest, lots of people are being diagnosed with anxiety lately, we don't even know how to cope with social situations anymore. What everyone should do is exercise daily & eat healthy. The panic attacks will soon go away. I was reading about how to deal with anxiety and was stunned about how easy people get over anxiety these days.

with more and more web sites providing information on general health issues or serious health concerns, we need to understand the likelihood of getting a particular illness and how it can affect you through different stages in your life. if something serious is going on with your body, it's best to discuss the symptoms with a professional before you "pick" a treatment plan on your own.

You can sure tell you don't have a clue about agoraphobia and panic. We who have it have heard all of what you say over and over. What you need to do is try and put yourself in the shoes of people that suffer this. Do you think they are all lying? You wouldn't say to a person with a crippled leg just get over it but you have no problem doing that to agoraphobics. I really don't want to get on your case because after all your just a human being that is trying to help I will assume but trust me when i say you are failing.

Perhaps it is you who are not listening. It is precisely the defining character of panic disorder that sufferers feel that they are out of control (or about to go out of control) when that is not true. In any case, I have listened to individuals with panic disorder for the last 40 years. I became interested in the condition when I developed it in college. It took me a number of years to recover. I am the Director of The Anxiety and Phobia Center at White Plains Hospital We have been in existence for over 40 years, and we have treated over an 8 week period over four thousand patients with this condition. You dismissal of our experience is self-serving. As long as you think there is no treatment for this condition, you can forgo undertaking the difficult effort that is required to recover.

Hi I am sorry I have upset you and I am sure you have every good intention but the methods they have been used in the past are not working. Maybe some cases have been helped but the majority of people with anxiety, panic and agoraphobia are still in their homes looking out. I have had it for 45 years and have now the answer for why I had it. It took that long for me to realize what was wrong. I have a blog at agoraphobiawhat.blogspot.com that explains this situation. I have also written a book called "MY Silent Disability" by Yolanda Antonino that is available for sale at Amazon. I don't believe in lashing out just for the fun of it. I guess I just got worked up after readying the same sorry stuff I have dealt with for years. My aim is first of all to help my family because this is inherited and second of all to help those out there who find no relief. The worst of which is those with traumatic brain injury. I write to you in a spirit of Love and don't mean to offend but to inlight.